Chpt 20

During your examination of a patient's abdomen, you note the presence of striae. This finding is MOST indicative of:

a change in the size of the abdomen over a short period of time.

A patient with an advanced bowel obstruction would MOST likely present with:

a feculent breath odor

A positive Murphy sign is characterized by:

a sudden stop in inspiration due to sharp pain when pressure is applied to the right upper quadrant.

You are caring for a middle-aged man with severe abdominal pain and dark, tarry stools. He is conscious but very restless. His blood pressure is 78/52 mm Hg, pulse rate is 130 beats/min and weak, and respirations are 24 breaths/min and shallow. Further assessment reveals that his skin is cool and clammy and his radial pulses are weakly present. You should:

administer high-flow oxygen, start two large-bore IV lines, and administer 20-mL/kg normal saline boluses until his radial pulses strengthen.

A 52-year-old man complains of vomiting and diarrhea for the past day. He is conscious and alert, has a blood pressure of 130/70 mm Hg, has a heart rate of 120 beats/min and strong, and has respirations of 20 breaths/min and regular. His past medical history is significant for anemia and congestive heart failure. Prior to administering isotonic crystalloid solutions to this patient, it is MOST important to:

auscultate his lung sounds

The MOST likely cause of Crohn disease is:

autoantibody destruction of the intestinal wall.

Intestinal adhesions would MOST likely result in:

bowel obstruction.

An incarcerated hernia is one that:

cannot be reduced and becomes trapped.

The ___________ controls the amount of food that moves back up the esophagus.

cardiac sphincter

An obese 52-year-old woman who presents with severe pain in the right upper quadrant of her abdomen and pain in her right shoulder is MOST likely experiencing:

cholecystitis

Icteric sclera and acholic stools are clinical manifestations of:

cirrhosis

Blood that has been digested by stomach acids manifests as:

coffee-ground emesis.

Dunphy sign is observed when:

coughing causes severe right lower quadrant pain.

Drinking alcohol with a fatty meal:

delays gastric emptying.

If water is not reabsorbed in the colon:

diarrhea occurs.

The pancreas, liver, and gallbladder connect to the digestive system at the:

duodenum

The exocrine function of the pancreas produces:

enzymes

Common signs and symptoms of acute gastroenteritis include all of the following, EXCEPT:

fever

Bile is stored in the _________ and is released into the __________, where it helps to _______.

gallbladder, duodenum, emulsify fats

A patient with pancreatitis would MOST likely present with pain that:

goes straight through to the back in the midline of the lower thoracic area

Pyloric stenosis is the most common cause of:

infantile intestinal obstruction.

The conversion of glycogen to glucose occurs in the:

liver

The portal vein transports venous blood from the gastrointestinal tract directly to the:

liver

Hepatic encephalopathy is a condition in which:

liver disease causes reduced brain function.

When auscultating bowel sounds, borborygmi is characterized by:

loud gurgles occurring greater than 30/min.

A patient with orthostatic vital sign changes:

may faint upon standing.

A 52-year-old man complains of severe abdominal pain but denies nausea or vomiting. He is conscious and alert, has a blood pressure of 130/70 mm Hg, a heart rate of 120 beats/min and strong, and respirations of 20 breaths/min and regular. In addition to providing supplemental oxygen, you should start an IV line and give:

nalbuphine, 10 mg.

Hypotension during an episode of dehydration indicates that the body is:

no longer capable of effectively pulling fluid from the interstitial space and the cellular area.

When diarrhea contains more water than it does fecal material:

smaller amounts of electrolytes are lost compared to the amount of lost water.

Irritation or injury to abdominal tissue, causing activation of peripheral nerve tracts, would MOST likely result in ___________ pain.

somatic

Filtering of blood and recycling of dead red blood cells are functions of the:

spleen

When forming your general impression of a patient with gastrointestinal distress, which of the following observations would provide the MOST information regarding what happened?

Body posture or position

Which of the following statements regarding Grey Turner sign is correct?

Grey Turner sign is characterized by flank bruising and indicates retroperitoneal hemorrhage.

Which of the following behaviors does NOT place a person at risk for gastrointestinal disease?

High-fiber diet

Which of the following assessment findings or techniques would prove MOST useful when determining the extent of internal volume loss?

Orthostatic vital signs

Which of the following conditions would be the LEAST likely to result in peritonitis?

Splenic laceration

Which of the following is NOT a function of the liver?

Storage of bile

You are dispatched to a residence for a 33-year-old woman with excruciating pain to the right lower quadrant of her abdomen. She is conscious and alert and tells you that she has been experiencing pain to the same area for the past few days. Her blood pressure is 110/66 mm Hg, pulse rate is 118 beats/min and strong, and respirations are 22 breaths/min with adequate depth. Her skin is warm and moist. The MOST appropriate treatment for this patient involves:

oxygen via nonrebreathing mask, an IV of isotonic crystalloid set to keep the vein open, morphine or fentanyl, and prompt transport.

Chronic use of nonsteroidal anti-inflammatory drugs would MOST likely result in:

peptic ulcer disease.

A protuberant abdomen would MOST likely be encountered in a patient with:

peritoneal fluid accumulation.

Esophageal varices are a direct result of:

portal hypertension.

Peristalsis is defined as:

rhythmic contraction

If a patient complains of left lower quadrant abdominal pain, you should FIRST palpate the:

right upper quadrant

In contrast to a patient with peritonitis, a patient with hepatitis would MOST likely initially experience:

right upper quadrant pain.

A sudden onset of discomfort in the throat, severe dysphagia, and vomiting bright red blood are MOST indicative of:

ruptured esophageal varices.

The presentation of Mallory-Weiss syndrome is linked to _________ and is caused by _________.

severe vomiting, a tear at the junction between the esophagus and stomach

Most of the digestive process occurs in the:

small intestine.

A 38-year-old man presents with an acute onset of severe right upper quadrant abdominal pain, pain to his right shoulder, and nausea. He is conscious and alert, but is restless from the pain. His blood pressure is 150/86 mm Hg, pulse rate is 120 beats/min and strong, and respirations are 22 breaths/min and regular. In addition to administering supplemental oxygen, you should:

start an IV with normal saline and set it to keep the vein open, place him in a position of comfort, and administer 4 mg of morphine and 12.5 mg of promethazine.

Patients with an extremely advanced bowel obstruction may have feculent breath, which is the odor of:

stool

A 62-year-old man presents with an acute onset of bright red vomiting. According to his wife, he ingests excessive amounts of alcohol each day. As you are assessing the patient, you note that his level of consciousness has decreased markedly. His mouth is full of blood, and his skin is pale and moist. You should:

turn him on his side and suction his oropharynx, intubate his trachea if the oral bleeding continues, establish at least one large-bore IV with normal saline, and administer enough fluids to maintain adequate perfusion.